Comparative Analysis of Tools for Assessment of Protein-Energy Wasting in Chronic Kidney Disease Patients on Maintenance Hemodialysis

Abstract

Background: Patients with chronic kidney disease have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. The present study assessed the prevalence of protein-energy wasting in dialysis-dependent chronic kidney disease population and evaluated the validity of various nutritional assessment tools in diagnosing protein-energy wasting.

Materials and methods: All patients above 18 years undergoing dialysis for more than 3 months without any active infection or malignancy were included in our study. Data from anthropometric measurements, dietary assessment, and blood investigations were collected. Protein-energy wasting was assessed by the International Society of Renal Nutrition and Metabolism 2008 criteria. Diagnostic validity of the nutritional assessment tools to predict protein-energy wasting was estimated by area under the curve, sensitivity, specificity, and accuracy statistics.

Results: A total of 146 patients were studied. The prevalence of protein-energy wasting was 56.8%. Protein-energy wasting was significantly associated with socioeconomic status, hospitalization days, and catheter days. Normalized protein catabolism rate had the highest sensitivity (90.4%) for predicting protein-energy wasting. Malnutritional inflammatory score had the highest area under the curve (0.858), specificity (82.5%), and accuracy (82.2%). Mid-upper arm circumference, Dialysis Malnutrition Score, and albumin were also found to be significant predictors of protein-energy wasting.

Conclusion: Lack of advanced equipment in suburban and rural centers to detect protein-energy wasting in India can be overcome by using the various stand-alone and combination nutrition assessment tools which have been validated in the present study.

Keywords: Chronic kidney disease; Maintenance hemodialysis; Malnutrition; Malnutrition Inflammation Score; Nutritional assessment; Protein–energy wasting.

Figure 1:

Sequence of the study process.

Figure 2:

ROC curves for predicting PEW: (a) MUAC, (b) MUST, (c) DMS, (d) MIS. DMS = Dialysis Malnutrition Score, MIS = Malnutrition Inflammation Score, MUAC = mid-upper arm circumference, MUST = Malnutrition Universal Screening Tool, PEW = protein–energy wasting, ROC = receiver operator characteristic.

Figure 3:

ROC curves for predicting PEW: (a) NPCR, (b) albumin, (c) simplified creatinine index. NPCR = normalized protein catabolic rate, PEW = protein–energy wasting, ROC = receiver operator characteristic.